Boutros Celina F, Khazaal Walaa, Taliani Maram, Sadier Najwane Said, Salameh Pascale, Hosseini Hassan
Institut Mondor de Recherche Biomédicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France.
Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
BMC Psychiatry. 2025 May 31;25(1):558. doi: 10.1186/s12888-025-06997-9.
About 1 in 2 stroke survivors suffer from anxiety and depression in the first year after stroke. This study aimed to calculate the proportions of 1-year post-stroke anxiety and depression (PSA and PSD), evaluate their changes over time, and identify the contributing factors among first-ever stroke survivors in Lebanon, where relevant research has been scarce.
A hospital-based multicenter study was conducted among 150 subjects aged ≥ 18 years involving scheduled home visits at 3, 6, and 12 months after stroke index. Several scales were employed, including Hospital Anxiety and Depression Scale (HADS), Mini-Mental State Examination (MMSE), modified Rankin Scale (mRS), Short Form Health Survey (SF12), National Institutes of Health Stroke Scale (NIHSS), Visual Analogue Scale (VAS), Douleur Neuropathique 4 (DN4), Modified Ashworth Scale (MAS), and Fatigue Severity Scale (FSS), to assess levels of anxiety and depression, cognitive function, disability degree, quality of life, stroke severity, general pain, central pain, spasticity, and fatigue after stroke, respectively. Descriptive analyses were performed to describe baseline and stroke characteristics and to calculate proportions of PSA and PSD, followed by univariate and multivariable analyses to identify the contributing factors.
High HADS scores were reported in our cohort, with the most prevalent symptoms occurring within the first 3 months after stroke index (77.3% for PSD and 51.2% for PSA with HADS ≥ 8). Despite a slight decrease over the subsequent 6 and 12 months, proportions remained elevated, affecting at least 40% to 60% of survivors. PSA was a consistent independent predictor of PSD (Adjusted Odds Ratio ≅ 2). Other contributing factors to PSA and PSD were highlighted, including a history of atrial fibrillation, longer sedentary hours, high scores of NIHSS and mRS, lower scores of SF12 and MMSE, and the presence of immobility-related problems, of which high DN4 scores were independent predictors. Better 1-year psychological outcomes were noticed in those with higher educational levels and employment after stroke.
Routine psychological screening and support for stroke survivors are urgently needed. By identifying factors and emphasizing early detection, our research offers valuable insights that can inform clinical practice and improve the well-being of stroke survivors.
约二分之一的中风幸存者在中风后的第一年患有焦虑症和抑郁症。本研究旨在计算中风后1年焦虑症和抑郁症（PSA和PSD）的比例，评估其随时间的变化，并确定黎巴嫩首次中风幸存者中的影响因素，该国相关研究较少。
在150名年龄≥18岁的受试者中开展了一项基于医院的多中心研究，包括在中风指数后的3、6和12个月进行定期家访。使用了多个量表，包括医院焦虑抑郁量表（HADS）、简易精神状态检查表（MMSE）、改良Rankin量表（mRS）、健康调查简表（SF12）、美国国立卫生研究院卒中量表（NIHSS）、视觉模拟量表（VAS）、神经病理性疼痛4量表（DN4）、改良Ashworth量表（MAS）和疲劳严重程度量表（FSS），分别评估中风后的焦虑和抑郁水平、认知功能、残疾程度、生活质量、中风严重程度、一般疼痛、中枢性疼痛、痉挛和疲劳。进行描述性分析以描述基线和中风特征，并计算PSA和PSD的比例，随后进行单变量和多变量分析以确定影响因素。
我们队列中的HADS得分较高，最普遍的症状出现在中风指数后的前3个月内（PSD为77.3%，PSA为51.2%，HADS≥8）。尽管在随后的6个月和12个月中略有下降，但比例仍然很高，至少影响40%至60%的幸存者。PSA是PSD的一致独立预测因素（调整后的比值比≅2）。还强调了PSA和PSD的其他影响因素，包括心房颤动病史、久坐时间较长、NIHSS和mRS得分较高、SF12和MMSE得分较低以及存在与活动障碍相关的问题，其中高DN4得分是独立预测因素。中风后教育水平较高和就业的患者1年心理结局较好。
迫切需要对中风幸存者进行常规心理筛查和支持。通过识别因素并强调早期检测，我们的研究提供了有价值的见解，可为临床实践提供参考并改善中风幸存者的健康状况。
